Robot-assisted laparoscopic partial nephrectomy

Purpose: Laparoscopic partial nephrectomy is a treatment option for small renal masses. However, such time-consuming techniques such as tumor excision, hemostasis and mitracoporeal suturing are still challenging procedures even for experienced laparoscopists. Incorporation of a robotic system would facilitate tumor excision, hemostasis and intracoporeal suturing. Herein, we review our technique and the short term outcomes for robot-assisted laparoscopic partial nephrectomy (RLPN). Materials and Methods: Eleven patients underwent RLPN for small renal masses. RLPN were performed with the da Vinci® robot system (Intuitive Surgical, Sunnyvale, USA) with three robot arms. In 7 cases, the renal hilum was clamped. Tumor excision and intracorporeal suturing were performed entirely with the robotic system. The specimen was extracted through the extended umbilical port incision. Results: The mean tumor diameter was 2.5±1.5cm. The mean operative time was 179.5±49.4 minutes and the mean estimated blood loss was 354.5±440.7ml. The mean warm ischemia. time was 30.4±5.9 minutes for 7 patients. There were no major, complications. The surgical pathology showed clear cell type renal cell carcinoma in 7, papillary type renal cell carcinoma in 1, angiomyolipoma in 2 and lipoma in 1. There were no positive surgical margins. The mean hospital stay was 4.2±1.3 days. No recurrence had been observed after 3 to 18 months of follow-up. Conclusions: We were able to verify the feasibility and safety of using a RLPN in the management of small renal masses. Longer follow-up data and larger prospective studies care necessary to confirm these results.